Provider Demographics
NPI:1821769720
Name:STEPHENSON, LISA MARIE
Entity Type:Individual
Prefix:PROF
First Name:LISA
Middle Name:MARIE
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-4237
Mailing Address - Country:US
Mailing Address - Phone:330-757-4099
Mailing Address - Fax:330-757-3774
Practice Address - Street 1:3130 CENTER RD
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-4237
Practice Address - Country:US
Practice Address - Phone:330-757-4099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-18309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist